Titman A, Rogers C A, Bonser R S, Banner N R, Sharples L D
MRC Biostatistics Unit, Robinson Way, Cambridge, UK.
Am J Transplant. 2009 Jul;9(7):1640-9. doi: 10.1111/j.1600-6143.2009.02613.x.
The lung transplantation candidate population is heterogeneous and survival benefit has not been established for all patient groups. UK data from a cohort of 1997 adult (aged > or = 16), first lung transplant candidates (listed July 1995 to July 2006, follow-up to December 2007) were analyzed by diagnosis, to assess mortality relative to continued listing. Donor lungs were primarily allocated according to local criteria. Diagnosis groups studied were cystic fibrosis (430), bronchiectasis (123), pulmonary hypertension (74), diffuse parenchymal lung disease (564), chronic obstructive pulmonary disease (COPD, 647) and other (159). The proportion of patients in each group who died while listed varied significantly (respectively 37%, 48%, 41%, 49%, 19%, 38%). All groups had an increased risk of death at transplant, which fell below waiting list risk of death within 4.3 months. Thereafter, the hazard ratio for death relative to listing ranged from 0.34 for cystic fibrosis to 0.64 for COPD (p < 0.05 all groups except pulmonary hypertension). Mortality reduction was greater after bilateral lung transplantation in pulmonary fibrosis patients (p = 0.049), but not in COPD patients. Transplantation appeared to improve survival for all groups. Differential waiting list and posttransplant mortality by diagnosis suggest further use and development of algorithms to inform lung allocation.
肺移植候选人群具有异质性,并非所有患者群体都已证实能从肺移植中获得生存益处。对英国1997例成年(年龄≥16岁)首次肺移植候选者(1995年7月至2006年7月登记,随访至2007年12月)的数据按诊断情况进行分析,以评估相对于继续登记而言的死亡率。供肺主要根据当地标准分配。所研究的诊断组包括囊性纤维化(430例)、支气管扩张症(123例)、肺动脉高压(74例)、弥漫性实质性肺疾病(564例)、慢性阻塞性肺疾病(COPD,647例)和其他(159例)。各诊断组中登记期间死亡的患者比例差异显著(分别为37%、48%、41%、49%、19%、38%)。所有组在移植时死亡风险均增加,且在4.3个月内降至等待名单上的死亡风险以下。此后,相对于登记而言的死亡风险比范围从囊性纤维化的0.34到COPD的0.64(除肺动脉高压组外,所有组p<0.05)。肺纤维化患者双侧肺移植后死亡率降低更明显(p=0.049),但COPD患者并非如此。移植似乎能提高所有组的生存率。按诊断情况区分的等待名单和移植后死亡率提示,需要进一步应用和开发算法以指导肺分配。